The Bottom Line: Why Hospitals are Increasingly Turning to Tele-ICU for Improved Outcomes

Demand for critical care is on a rapid growth trajectory in the United States. Characterized by high-costs and high-risk, intensive care units (ICUs) presents notable opportunities and challenges for healthcare executives in the evolving quality-driven healthcare landscape.

While ICUs account for a mere 10% of hospital beds, they typically generate approximately 30% of hospital costs and house patients with some of the highest acuity and greatest potential for adverse events. Simply put, stakes are high in the ICU, and a hospital’s effectiveness in treating its most critical patients has marked impact on its overall performance and reputation.

As industry statistics point to the growing challenge of greater demand for critical care against a flat supply of intensivists (physicians certified in critical care), hospitals are having to look outside of traditional critical care delivery models to position for the future. Partnering with a telemedicine provider that offers 24/7 remote monitoring by trained intensivist-led critical care teams complements and expands the work of bedside intensive care unit (ICU) care teams. It’s why adoption rates for tele-ICU services are accelerating.

Tele-ICU on the Move

A 2014 telemedicine survey conducted by Foley and Lardner revealed that 90 percent of healthcare leaders had begun implementing a telemedicine program and the majority of respondents are already leveraging remote monitoring to enhance care delivery. Use of tele-ICU services is often part of this strategy as hospitals identify and deploy effective models for enhancing clinical performance, optimizing operational efficiency and managing the imbalances associated with critical care resource supply and demand.

The advantages of collaborative care models, like the one offered through Advanced ICU Care, are many and foundationally begin with the ability to provide Leapfrog-compliant 24/7 intensivist care—the proven industry gold standard. By utilizing highly-trained, intensivist-led care teams who are empowered by a constant inflow of patient information highlighted by smart algorithms and alerts, the work of the bedside team is augmented. This powerful combination drives better ICU patient outcomes, progressively increases alignment with best-ICU clinical care practices and delivers a compelling return on investment (ROI).

A 2014 study published in CHEST revealed an overall reduction in mortality rates of 13 percent and a reduction in length of stay by 30 percent across 56 intensive care units that included tele-ICU capabilities over a five-year period. Improving on those impressive statistics, clients of Advanced ICU Care have historically realized 30-40 percent reductions in mortality rates and 25-30 percent reductions in average length of ICU patient stays.

Elevating ICU Care Delivery

The increased adoption of tele-ICU is a clear step forward and demonstrates the model’s proven ability to positively impact patient outcomes and ICU processes in a data-driven, fiscally-responsible, ROI-positive manner.

Expanding Specialized Patient Care

In addition to the skilled critical care teams employed, technology and information sharing form another important component of the tele-ICU model. Continuously evolving state-of-the-art technology provides actionable, analyzed data in real time, which in turn materially augments and enhances ICU patient care.

Because the tele-ICU care delivery model promotes and facilitates real-time collaboration between tele-intensivists, advanced practitioners, critical care RNs and other bedside clinicians, it has proved highly effective for elevating patient care with or without the presence of intensivist staffing at the hospital bedside. By forging a collaborative partnership with the bedside teams and understanding ICU care team goals, Advanced ICU Care medical directors and account managers are able to work cooperatively with client medical leadership to suggest, prioritize and address opportunities for care, outcomes, quality and process improvement.

Critical patient-centric information is aggregated from a wide range of sources to enable earlier identification of negative trends in individual patient condition, thus allowing increasingly proactive responses. When an issue is identified, collaborative engagement often enables more rapid care delivery to the patient in need. When urgent situations do occur, Advanced ICU Care intensivists are literally a push of a button away and can be virtually present in any ICU room typically within 60 seconds.

In essence, collaborative tele-ICU models offer the opportunity to make care delivery more proactive than reactive in nature, optimizing clinical response and patient care through ongoing exchange of patient information. Unlike traditional “call us if you have a problem” episodic models, which wait for a problem to present and other care options to be exhausted, 24/7 tele-ICU patients benefit from the availability of intensivists who are not “on call” but rather “always informed and always on duty”.

Smarter Alerting Systems

While bedside alarm systems are intended to be positive enhancements to patient care, their effectiveness is often minimized due to a lack of system sensitivity to the nuances of an individual patient’s condition. Typical alarm systems are activated when certain vital signs meet predetermined criteria and do not take into account the context or circumstances of a particular patient’s care.

An ever-evolving, state-of-the-art remote monitoring framework powers a constant stream of patient health data, creating richer, more contextually-relevant alerts. For example, an elevated heart rate might ordinarily trigger an alarm, but if a patient is in the ICU due to a heart attack, parameters for heart rate would be viewed contextually by the alerting system before an alarm is activated.

When alerting parameters can be framed in this way to reflect a patient’s true condition, the end result is fewer, but smarter overall alerts, ensuring better allocation of clinicians’ time and improving responsiveness to changes in patients’ conditions.

Better data for standardizing best practices

Regular tracking and reporting of a large number of clinical and non-clinical metrics by a tele-ICU partner—including admissions, mortality, length of stay, ventilator management, blood transfusion and glucose management—allow hospitals to see how they are performing and potentially identify opportunities for improvement. Access to data at this granular level is a significant value-add for nearly all ICUs—most of which exist within hospital eco-systems long hindered by limited sight into performance metrics and the ability to identify where process/quality initiatives can most impact operations.

Data amassed by Advanced ICU Care through the nation’s largest installed base of remotely monitored ICUs provides a unique framework for converting collaboration to insight, where the effectiveness of a client’s clinical initiatives can be measured, analyzed and benchmarked. For example, working collaboratively with Advanced ICU Care, a hospital system was able to improve adherence to stress ulcer protocols from 73% to 100% compliance. In separate work at a mid-sized Regional Medical Center (RMC), Advanced ICU Care and clinical leadership identified an opportunity to enhance an insulin drip protocol to improve glycemic control. In the first 18 months of using the revised protocol, average daily glucose fell 11.8%.

Conclusion

Tele-ICU services—when designed and delivered optimally—provide daily demonstrations of how the combination of collaborative care teams, advanced technology and evolving and improving ICU practices can deliver an impressive opportunity to expand and optimize ICU patient care. When clinical expertise, dedicated technology and robust data come together, the results can be, quite literally, lifesaving.